@article{Khedim_C-2020_44653,
title = {Paediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in a patient receiving Infliximab therapy for Inflammatory Bowel Disease},
author = {Khedim, C. and Meredith, J. and Henderson, P. and Wilson, D. and Russell, R.},
month = {sep},
year = {2020},
abstract = {Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 [PIMS-TS] is a newly described condition. It has a spectrum of presentations proposed to occur as part of a post-infectious immune response. We report the first case of PIMS-TS in a child on established anti-tumour necrosis factor alpha [anti-TNFα] therapy; a 10 year-old girl with ulcerative colitis treated with infliximab. The patient had 6 weeks of daily fever with mucocutaneous, gastrointestinal, renal, and haematological involvement. Biomarkers of hyperinflammation were present including: hyperferritinaemia [up to 691 µ/L; normal 15–80 µg/L], C-reactive protein [CRP] [ &gt;100mg/L for  &gt;10 days, normal 0–5 mg/L], erythrocyte sedimentation rate [ESR] consistently  &gt;100mm/h [normal 0–15 mm/h], raised white cell count with neutrophilia, elevated D-dimer and lactate dehydrogenase [LDH], anaemia and Mott cells on bone marrow analysis. Extensive investigations for alternative diagnoses for pyrexia of unknown origin [PUO] were negative. The condition was refractory to treatment with intravenous immunoglobulin [IVIG] but improved within 24 h of high-dose methylprednisolone. Infliximab treatment followed and the patient has remained well at follow-up. Polymerase chain reaction [PCR] and serology for SARS-CoV-2 were negative. Current series report such negative findings in up to half of cases. The patient experienced a milder clinical phenotype without cardiac involvement, shock, or organ failure. Accepting the wide spectrum of PIMS-TS presentations, it is possible that previous anti-TNFα therapy may have attenuated the disease course. Given the uncertainty around therapeutic strategies for PIMS-TS, this case supports the need for further investigation into continuing infliximab as a treatment option for the condition.},
pages = {687-691},
volume = {15},
issue = {4},
journal = {Journal of Crohn's and Colitis},
publisher = {Oxford University Press},
url = {https://doi.org/10.1093/ecco-jcc/jjaa201},
}
